Homelessness in America

Transcription

1 in America Media Handbook January 2007

2 in America Media Handbook January 2007 This handbook was prepared by Nell McGarity, Allison Conyers, and Mary Cunningham of the Research Institute at the National Alliance to End. We would like to thank the journalists and communicators who offered assistance with this guide: Buck Baggot, Consultant Amrit Dillion, National Low Income Housing Coalition Kevin Fagan, San Francisco Chronicle Henry Griggs, Center on Budget and Policy Priorities Lyn Hikida, Corporation for Supportive Housing Douglas McGray, Freelance Journalist Cheryl Weitzstein, The Washington Times Mary Otto, The Washington Post The authors take full responsibility for this product, and the contributors and listed experts should not be viewed as endorsing this material. All errors or omissions are the responsibility of the authors. The National Alliance to End is a nonpartisan, mission-driven organization committed to preventing and ending homelessness in the United States. Our Work The National Alliance to End is a leading voice on the issue of homelessness. The Alliance analyzes policy and develops pragmatic, cost-effective policy solutions. We work collaboratively with the public, private, and nonprofit sectors to build state and local capacity, leading to stronger programs and policies that help homeless individuals and families make positive changes in their lives. We provide data and research to policymakers and elected officials in order to inform policy debates and educate the public and opinion leaders nationwide.

3 in America Media Handbook Contents Introduction 1 by the Numbers 2 Family 6 Homeless Adults 8 Rural 9 Youth 11 Veterans 12 Prisoner Reentry 14 Domestic Violence 15 Mental and Physical Health and Substance Abuse 16 Frequently Asked Questions 18 How Much Does the Federal Government Spend on? 18 What Is Housing First? 19 What Is Permanent Supportive Housing? 19 What Is the Ten Year Plan? How Many Local Ten Year Plans Exist? 20 Endnotes 20 i

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5 Introduction is one of our nation s most misunderstood and vexing social problems. Because homelessness is complex, it is often difficult for the media to cover the issue with the background and nuance necessary to capture the full picture, particularly for stories that are time sensitive. Events that affect individuals or families who are homeless or at risk of homelessness may arise quickly and require immediate action to track down background, relevant sources, and experts. Quantitative data are often disjointed, expansive, or difficult to find and process in a short amount of time. This guide aims to streamline this process by providing context and reliable sources for reporters to access quickly. The goal of this guide is to stimulate thoughtful and insightful reporting on a population that is often poorly understood. While typical stories on homelessness often involve local panhandling ordinances or deaths of homeless people caused by extreme weather valued coverage that brings attention to the issue these stories can be developed further into examinations of what strategies are effective in ending homelessness, how communities can better address the needs of their homeless population, or how future homelessness can be prevented. In this guide, we present homelessness issues by population. We hope that by providing quick facts, background, and a listing of the most knowledgeable experts, more enriching and informative reporting will result. 1

6 by the Numbers Resources The most common question about homelessness is how many people are currently homeless. Prior to this year, the last nationwide estimate of the number of homeless people the National Survey of Homeless Assistance Providers and Clients (NSHAPC) was taken over 10 years ago in The research was sponsored by the Interagency Council on and conducted by the Urban Institute. The study found that between 444,000 and 842,000 people in the United States were homeless. This estimate provides data on how many people are homeless at a specific point in time. However, the reality is that the homeless population is quite National Alliance to End The Urban Institute The 1996 National Survey of Homeless Assistance Providers and Clients homeless/homeless_tech.html Expert Sources Martha Burt, Urban Institute Dennis Culhane, University of Pennsylvania Jill Khadduri, Abt Associates Nan Roman, National Alliance to End fluid people move in and out of homelessness and most people are homeless for only a short period of time. To create an annual estimate of how many people experience homelessness, researchers extrapolated this number, finding that between 2.3 and 3.5 million people per year experience homelessness. 1 Recently, the National Alliance to End Home - lessness compiled data from counts of local homeless populations. This study found that approximately 750,000 people were homeless on any given night in January

7 at a Glance Issue by the Numbers Family Homeless Adults At a Glance Prior to this year, the last nationwide estimate of the number of homeless people the National Survey of Homeless Assistance Pro - viders and Clients (NSHAPC) was taken over 10 years ago in The study found that between 444,000 to 842,000 people in the United States were homeless at any point in time. A recent study by the National Alliance to End found that about 750,000 experienced homelessness in January These estimates provide data on how many people are homeless at a specific point in time. However, the reality is that the homeless population is quite fluid people move in and out of homelessness and most people are homeless for only a short period of time. To create an annual estimate of homelessness, researchers extrapolated the 1996 estimate, finding between 2.3 and 3.5 million people per year experience homelessness. Every year 600,000 families with 1.35 million children experience homelessness in the United States. The existing and most conclusive research identifies the lack of affordable housing as the primary cause of homelessness among families in the United States. Studies have shown that families exiting homelessness with a housing subsidy remain stably housed over time; they are 21 times more likely to remain stably housed than comparable families exiting a shelter without a subsidy. Without a housing subsidy a family has to make $16.31 an hour ($33, annually) to afford housing at the national fair market rent; the hourly rate is much higher in higher-cost rental markets, such as Washington, DC; Boston, Massachusetts; and Alameda County, California. An overwhelming majority (80 percent) of single adult shelter users enters the homeless system only once or twice, stay just over a month, and do not return. Approximately 9 percent enter nearly five times a year and stay nearly two months each time. This group utilizes 18 percent of the system s resources. The remaining 10 percent enters the system just over twice a year and spends an average of 280 days per stay virtually living in the system and utilizing nearly half its resources. Many of these individuals are defined as chronically homeless. There are approximately 150,000 to 200,000 chronically homeless individuals nationwide. Experts Martha Burt, Urban Institute Dennis Culhane, University of Pennsylvania Jill Khadduri, Abt Associates Nan Roman, National Alliance to End Ellen Bassuk, National Center on Family Sheila Crowley, National Low Income Housing Coalition Debra Rog, Westat Nan Roman, National Alliance to End Marybeth Shinn, New York University Dennis Culhane, University of Pennsylvania Nan Roman, National Alliance to End Carol Wilkens, Corporation for Supportive Housing 3

8 at a Glance 4 Issue Rural Youth Homeless Veterans Prisoner Reentry At a Glance The exact number of people who experience rural homelessness is unknown, but the last national count of homeless people found that 9 percent live in rural areas. Many rural homeless people live in places we do not see; they often are sleeping in the woods, campgrounds, cars, abandoned farm buildings, or other places not intended for habitation. Many more individuals and families in rural areas live in substandard housing or are doubled-up. These households are at risk of homelessness. Although the prevalence of youth homelessness is difficult to measure, researchers estimate that about 5 to 7.7 percent of youth experience homelessness each year. The same factors that contribute to adult homelessness, such as poverty, lack of affordable housing, low education levels, unemployment, mental health, and substance abuse, can lead to homelessness among youths. Youths transitioning out of foster care are at high-risk of becoming homeless. Every year between 20,000 and 25,000 youths ages 18 and older age out of the foster care system. Convergent sources estimate that between 23 and 40 percent of homeless adults are veterans, which matches the proportion of veterans in the overall U.S. population. The veterans are of different wars and conflicts, including World War II, Korean War, Cold War, Vietnam War, Grenada, Panama, and Lebanon; research indicates that those serving in the late-vietnam and post-vietnam era are at greatest risk of homelessness. Recent media accounts highlight a small but growing trend of veterans from Iraq showing up in shelters; however, there has been no rigorous study documenting this phenomenon. Each year, more than 650,000 people are released from state prisons in the United States, and an estimated 12 million are released from jails. More than 10 percent of those coming in and out of prisons and jail are homeless in the months before their incarceration. Shelter use, both before incarceration and after release, is associated with an increased risk of return to prison: in a study of 50,000 individuals who were released from New York State prisons and returned to New York City between 1995 and 1998, the risk of reincarceration increased 23 percent with prerelease shelter stay, and 17 percent with postrelease shelter stay. Experts Martha Burt, Urban Institute Nan Roman, National Alliance to End Nan Roman, National Alliance to End Paul Toro, Wayne State University Cheryl Beversdorf, National Coalition for Homeless Veterans Nan Roman, National Alliance to End Robert Rosenheck, Yale Medical School Caterina Gouvis Roman, Urban Institute Nan Roman, National Alliance to End

9 at a Glance Issue Domestic Violence Mental and Physical Health At a Glance In a national survey of homeless people, domestic violence was the second most frequently stated cause of homelessness for families, with 13 percent of homeless families saying that they had left their last place of residence because of abuse or violence in the household. Domestic violence victims are often isolated from support networks and financial resources by their abusers. As a result they may lack steady income, employment history, credit history, and landlord references. Women survivors of physical assault also often suffer from anxiety, panic disorder, major depression, and substance abuse. An adequate supply of affordable housing is critical to ensuring survivors of domestic violence can afford to leave the shelter system as quickly as possible without returning to their abuser. In a national study, 46 percent of the homeless respondents had an alcohol use problem during the past year, and 62 percent had an alcohol use problem at some point in their lifetime. Thirty-eight percent had a problem with drug use during the past year, and 58 percent had a drug use problem during their lifetime. 46 percent of homeless people had one or more chronic health conditions and 26 percent had one or more acute infectious condition. The majority of homeless people (55 percent) did not have medical insurance of any kind. About 25 percent of the homelessness population had serious mental illness. Experts Ellen Bassuk, National Center on Family Nan Roman, National Alliance to End Arturo Bendixen, AIDS Foundation of Chicago Nancy Bernstine, National AIDS Housing Coalition Jim O Connell, Boston Healthcare for the Homeless Nan Roman, National Alliance to End Robert Rosenheck, Yale Medical School * You can find the complete citation to the facts listed in this table in their respective chapter. * To interview these experts, please contact their organizations. 5

10 Family Every year 600,000 families with 1.35 million children experience homelessness in the United States, making up about 50 percent of the homeless population over the course of the year. 3 Homeless families, mothers, fathers, grandparents, and children are scattered across the country. Families experiencing homelessness live in urban, suburban, and rural areas, sleeping in shelters, cars, motels, and abandoned buildings. The existing and most conclusive research identifies the lack of affordable housing as the primary cause of homelessness among families in the United States. 4 This is both because there is an inadequate supply of affordable housing and because incomes are so low that families cannot pay for the housing that is available. The rising cost of housing, accompanied by declining wages, creates conditions that put families at risk of losing their housing and makes it even more difficult for families to find housing once they become homeless. 5 6 The threat of homelessness looms constantly over most poor families who struggle to meet their rent or mortgage payments, but there are risk factors or predictors of homelessness that suggest that some families affected by the affordable housing crisis are more likely to become homeless than others. Families that become homeless tend to share certain characteristics: they have extremely low incomes, tend to have young children and be headed by a younger parent, lack strong social networks, and often have poor housing histories or move frequently. 6 That said, homeless families are, in many ways, very similar to other poor families who do not become homeless. Both housed and homeless poor families have the same (albeit high) incidences of domestic violence and similar rates of mental illness. 7 Both poor housed children and homeless children suffer from high rates of anxiety, depression, behavioral problems, or below-average school performance. 8 It seems that homeless families are a subgroup of poor

11 families that, for either an economic or a personal crisis, have lost their housing and cannot get back into the housing market. Studies have shown that families exiting homelessness with a housing subsidy remain stably housed over time; they are 21 times more likely to remain stably housed than comparable families exiting a shelter without a subsidy. 9 However, at current funding levels, federal programs cannot close the gap between those who can afford housing and those who cannot. Today, approximately 5 million households receive federal assistance to help pay for housing mostly in the form of Section 8 housing vouchers, which families can use to rent housing on the private market. 10 But there are 10 million families eligible for housing subsidies that do not receive them because of lack of funding. Most cities have waiting lists that stretch from two to five years for housing units and rent subsidies. Without a housing subsidy, a family has to make $16.31 an hour ($33, annually) to afford housing at the national fair market Resources National Alliance to End section/policy/focusareas/families National Alliance to End, Promising Strategies to End Family, June content/article/detail/999 National Center on Family National Low Income Housing Coalition Expert Sources Ellen Bassuk, National Center on Family Sheila Crowley, National Low Income Housing Coalition Debra Rog, Westat Nan Roman, National Alliance to End Marybeth Shinn, New York University rent; the hourly rate is much higher in higher-cost rental markets, such as Washington, DC; Boston, Massachusetts; and Alameda County, California. 11 In addition to housing, families experiencing homelessness need and benefit from services. Services can help families access and maintain stable housing as well as increase economic self-sufficiency and improve family and child well-being. Because families who experience homelessness have different needs, there is no cookie cutter service delivery model that works for all families. While some families are able to transition out of homelessness with minimal supportive services, others require more intensive supportive services to exit the homeless assistance system and remain stably housed. Once back in housing, links to mainstream services for example, mental health counseling, child development services, or employment training are important for building strong families that are no longer at risk of homelessness. 7

12 Homeless Adults 8 Resources About half of the people who experience homelessness over the course of a year are single adults. 12 Most enter and exit the homeless system fairly quickly. The remainder live in the homeless assistance system, or in a combination of shelters, hospitals, jails, and prisons or on the streets. An overwhelming majority (80 percent) of single adult shelter users enter the homeless system only once or National Alliance to End section/policy/focusareas/chronic National Alliance to End, Chronic Policy Brief content/article/detail/1060 Permanent Supportive Housing Cost- Effectiveness Study NYNYSummary.pdf Expert Sources Dennis Culhane, University of Pennsylvania Nan Roman, National Alliance to End Carol Wilkens, Corporation for Supportive Housing twice, stay just over a month, and do not return. Approximately 9 percent enter nearly five times a year and stay nearly two months each time. This group utilizes 18 percent of the system s resources. The remaining 10 percent enter the system just over twice a year and spend an average of 280 days per stay virtually living in the system and utilizing nearly half its resources. 13 Many of these individuals are defined by the Department of Housing and Urban Development (HUD) as chronically homeless. 14 They often cycle between homelessness, hospitals, jails, and other institutional care and often have a complex medical problem, a serious mental illness like schizophrenia, and/or alcohol or drug addiction. There are approximately 150,000 to 200,000 chronically home - less individuals nationwide. 15 Although

13 chronic homelessness represents a small share of the overall homeless population, chronically homeless people use up more than 50 percent of the services. 16 The most successful model for housing people who experience chronic homelessness is permanent supportive housing using a Housing First approach. Permanent supportive housing combines affordable rental housing with supportive services such as case management, mental health and substance abuse services, health care, and employment. Research shows that permanent housing is cost-effective, saving communities thousands of dollars in the cost of hospital stays, jail, and other institutional care. Rural America s small towns and communities are not immune to the problem of homelessness. The number of people who experience rural homelessness is unknown, but the last national count of homeless people found that 9 percent live in rural areas. 17 Advocates and researchers often refer to people who experience rural homelessness as the hidden homeless. Many rural homeless people live in places we do not see; they often are sleeping in the woods, campgrounds, cars, abandoned farm buildings, or other places not intended for habitation. Many more individuals and families in rural areas live in substandard housing or are doubled up. These households are at risk of homelessness. The same structural factors that contribute to urban homelessness lack of affordable housing and inadequate income also lead to rural homelessness. Historically, the greatest housing concern for rural Americans has been poor housing quality. There have been significant improvements in rural housing quality 9

14 Resources over the past several years; however, the fact remains that approximately 1.5 million (6.6 percent) rural homes are classified as substandard, according to the 2003 American Housing Survey. 18 Residents in substandard housing are often forced to seek safer, more expensive housing that they are unable to afford. As a result, poor-quality housing can lead to periods of homelessness. Insufficient income, high rates of poverty, and unemployment also lead to rural homelessness. Rural homelessness is most dramatic in areas that experience high economic growth, thus driving up housing costs, and in areas with high rates of unemployment because of declining industries, such as farming, timber, mining, or fishing. 19 The lack of available jobs and steady incomes means that household income is significantly lower in rural areas; according to the latest report by the U.S. Census Bureau, the median income for households living in National Alliance to End section/policy/focusareas/rural Housing Assistance Council Expert Sources Martha Burt, Urban Institute Nan Roman, National Alliance to End non-metropolitan areas was $37,564, compared to $48,474 for metropolitan areas. Poverty is a persistent problem in rural America. The national poverty rate is 12.6 percent, whereas the poverty rate in rural areas is 14.5 percent, 20 and 189 of the 200 poorest counties are rural. 21 Perhaps most staggering is the problem of child poverty. More than 19 percent of rural children live in poverty (an increase of over 3 percent from 2000). 22 As noted earlier, other predictors of homelessness, such as substance abuse and mental illness, contribute to rural homelessness. Those who experience rural homelessness report higher rates of alcohol abuse and domestic violence, but lower rates of mental illness and drug abuse than the urban homeless population. 23 However, more recent research suggests that, when looking at substance use trends for the entire population, there is no difference in reported substance abuse between rural and urban residents

15 Youth Youth homelessness is disturbingly common. Although the prevalence of youth homelessness is difficult to measure, researchers estimate that about 5 to 7.7 percent of youths experience homelessness each year. 25 The same factors that contribute to adult homelessness, such as poverty, lack of affordable housing, low education levels, unemployment, mental health, and substance abuse, can lead to homelessness among youths. Beyond these factors, youth homelessness is largely a reflection of family breakdown. 26 Youths become homeless for myriad reasons, including running away from home, being abandoned by their parents or guardians, being emancipated, or being discharged from some sort of state care. Although family conflict also plays a role in adult homelessness, the nexus is more critical for youths because they are, by virtue of their developmental state in life, still largely financially, emotionally, and, depending on their age, legally dependent upon their families. Youths transitioning out of foster care are at high risk of becoming homeless. Every year between 20,000 and 25,000 youths, ages 18 and older, age out of the foster care system. 27 Without a home, family support, or other resources, homeless youths are often locked up because they are without supervision. Homeless youths are socially marginalized and often arrested for status offenses, such as running away or breaking curfew. Twenty-five percent of former foster youths nationwide reported that they had been homeless at Resources National Alliance to End, Fundamental Issues of Preventing and Ending Youth content/article/detail/1058 Expert Sources Nan Roman, National Alliance to End Paul Toro, Wayne State University 11

16 least one night within 2.5 to 4 years after exiting foster care. 28 For youths who are released from juvenile corrections facilities, reentry is often difficult because they lack support systems and opportunities for work and housing. has serious consequences for young people and is especially dangerous for those between the ages of 16 and 24 who do not have familial support. Living in shelters or on the streets, unaccompanied homeless youths are at a higher risk for physical and sexual assault or abuse and physical illness, including HIV/AIDS. It is estimated that 5,000 unaccompanied youths die each year as a result of assault, illness, or suicide. 29 Furthermore, homeless youths are at a higher risk for anxiety disorders, depression, posttraumatic stress disorder (PTSD), and suicide because of increased exposure to violence while living on their own. 30 Homeless youths are also more likely to become involved in prostitution, to use and abuse drugs, and to engage in other dangerous and illegal behaviors. Veterans 12 Convergent sources estimate that between 23 and 40 percent of homeless adults are veterans, which matches the proportion of veterans in the overall U.S. population. 31 The U.S. Department of Veterans Affairs (VA) estimates that as many as 200,000 homeless people are veterans, and that over the course of the year, as many as 500,000 veterans experience homelessness. The veterans are of different wars and conflicts, including World War II, Korean War, Cold War, Vietnam War, Grenada, Panama, and Lebanon; research indicates that those serving in the late- Vietnam and post-vietnam era are at greatest risk of homelessness. Recent media accounts highlight a small but growing trend of veterans from Iraq and Afghanistan showing up in shelters; however, there has been no rigorous study documenting this phenomenon.

17 Most homeless veterans are male. The VA estimates that as few as 3 percent of homeless veterans are female; however, this number has the potential to increase over time as the number of women veterans increases. The National Survey of Homeless Assistance Providers and Clients (NSHAPC), conducted in 1996, found that almost 46 percent of homeless veterans were white males and 46 percent were 45 or older; more than half (56 percent) had completed high school or a GED program. An overwhelming majority (76 percent) of respondents in the survey reported experiencing alcohol, drug, or mental health problems. Homeless veterans re ported needing help finding a job (45 percent) and finding housing (37 percent). 32 The causes of homelessness among veterans are difficult to disentangle. Homeless veterans suffer from high rates of PTSD and mental illness. While these rates are high, they are similar to the rates of mental health problems in other homeless adults. Robert Rosenheck (1996), a re - searcher at Yale Medical School, writes that homelessness among veterans is not clearly related to military experience. Rather, it is the result of the same interrelated economic and personal factors that cause homelessness in the civilian population. 33 In other words, the same things that predict homelessness among the Resources National Alliance to End section/policy/focusareas/veterans National Alliance to End, Fact Checker: and Veterans content/article/detail/1401 National Coalition for Homeless Veterans Expert Sources Cheryl Beversdorf, National Coalition for Homeless Veterans Nan Roman, National Alliance to End Robert Rosenheck, Yale Medical School general population poverty, health and mental health issues, lack of affordable housing also predict homelessness among veterans. However, veterans face additional challenges when trying to overcome these obstacles: prolonged separation from traditional supports such as family and close friends; highly stressful training and occupational demands that can affect their personality, selfesteem and ability to communicate; and non-transferability of skills to civilian jobs. Studies show that up to one-third of combat veterans are likely to experience some clinical degree of depression, post-traumatic stress disorder, or other emotional and psychological difficulties directly related to their military expense

18 Prisoner Reentry 14 Resources National Alliance to End section/policy/focusareas/reentry National Alliance to End, Prison Reentry and content/article/detail/1082 Re-Entry Policy Council Urban Institute Expert Sources Caterina Gouvis Roman, Urban Institute Nan Roman, National Alliance to End Each year, more than 650,000 people are released from state prisons in the United States, and an estimated 12 million are released from jails. 35,36 Many former prisoners are at risk of homelessness, and if these individuals do become homeless, their likelihood of returning to prison increases because they are more likely to violate their parole, either for technical violations or by committing a crime. Conversely, more than 10 percent of those coming in and out of prisons and jail are homeless in the months before their incarceration. For those with mental illness, the rates are even higher about 20 percent. 37 Forty-nine percent of homeless adults have reportedly spent five or more days in a city or county jail over their lifetimes, and 18 percent have been incarcerated in a state or federal prison, according to a 1996 HUD study. 38 Shelter use, both before incarceration and after release, is associated with an increased risk of return to prison. In a study of 50,000 individuals who were released from New York State prisons and returned to New York City between 1995 and 1998, the risk of returning to prison increased 23 percent with prerelease shelter stay, and 17 percent with post-release shelter stay. 39 Prison and jail are among the most expensive settings to serve people who are homeless: one nine-city study calculated median daily costs for prison

19 and jail at $59.43 and $70.00, respectively, compared with $30.48 for supportive housing. 40 Supportive housing has been documented to drastically reduce criminal justice involvement, reducing jail incarceration rates up to 30 percent and prison incarceration rates up to 57 percent. 41 Domestic Violence Domestic violence is the immediate cause of homelessness for many women. In a national survey of homeless people, domestic violence was the second most frequently stated cause of homelessness for families, with 13 percent of homeless families saying that they had left their last place of residence because of abuse or violence in the household. 42 Other local surveys have found even higher percentages of families becoming homeless as a direct result of domestic violence. The consequences of domestic violence can affect a woman s likelihood of becoming homeless. Domestic violence victims are often isolated from support networks and financial resources by their abusers. As a result, they may lack steady income, employment history, credit history, and landlord references. Women survivors of physical assault also often suffer from anxiety, panic disorder, major depression, and substance abuse. 43 Resources National Alliance to End section/policy/focusareas/violence National Network to End Domestic Violence National Center on Family Expert Sources Ellen Bassuk, National Center on Family Nan Roman, National Alliance to End 15

20 Many homeless women have been victims of domestic violence at some point in their past, even if they do not identify it as the immediate cause of their homelessness. One study in Massachusetts found that 92 percent of homeless women had experienced severe physical or sexual assault at some point in their life, 63 percent had been victims of violence by an intimate partner, and 32 percent had been assaulted by their current or most recent partner. 44 Domestic violence victims have both short- and long-term housing needs that must be met so that they do not need to choose between staying with their abuser and sleeping on the street. Immediately, domestic violence victims need a safe place to stay. Emergency shelters are an important temporary haven for domestic violence victims. Ultimately, domestic violence victims need safe, stable, and affordable housing. An adequate supply of affordable housing is critical to ensuring that survivors of domestic violence can afford to leave the shelter system as quickly as possible without returning to their abuser. Mental and Physical Health and Substance Abuse 16 Homeless people suffer from high rates of mental and physical health problems exacerbated by living on the streets and in shelters. The lack of residential stability makes health care delivery more complicated. Health conditions that require ongoing treatment such as diabetes, cardiovascular diseases, tuberculosis, HIV/AIDS, and mental illness are difficult to treat when people are living in shelter or on the streets. 45 Homeless people often lack access to preventative care, waiting until a trip to the emergency room is a matter of life or death. These emergency room visits are costly. Additionally, when homeless people become ill, they often do not receive timely treatment.

21 In addition to chronic health problems, approximately half of homeless people suffer from mental health issues. At a given point in time, 45 percent of homeless people report indicators of mental health problems during the past year, and 57 percent report having had a mental health problem during their lifetime. 46 About 25 percent of the homelessness population has serious mental illness, including such diagnoses as chronic depression, bipolar disorder, schizophrenia, schizoaffective disorders, and severe personality disorders. 47 Many homeless people have problems with drug and alcohol use. In a 1996 survey, 46 percent of the homeless respondents had an alcohol use problem during the past year, and 62 percent had an alcohol use problem at some point in their lifetime. Thirty-eight percent had a problem with drug use during the past year, and 58 percent had a drug use problem during their lifetime. 48 Resources National Alliance to End section/policy/focusareas/health National Healthcare for the Homeless Council National Alliance on Mental Illness Expert Sources Arturo Bendixen, AIDS Foundation of Chicago Nancy Bernstine, National AIDS Housing Coalition Jim O Connell, Boston Healthcare for the Homeless Nan Roman, National Alliance to End Robert Rosenheck, Yale Medical School 17

22 Frequently Asked Questions How Much Does the Federal Government Spend on? Answering the question about how much the federal government spends on homelessness should be as simple as summing the total expenditures for homeless assistance programs. Homeless programs, however, do not fit neatly into one federal agency; instead they are spread across several, including the Department of Housing and Urban Development (HUD), the Department of Health and Human Services (HHS), The Social Security Administration (SSA), the Department of Homeland Security (DHS), and the Department of Veterans Affairs (VA). These federal agencies administer programs that are dedicated to serving homeless people meaning that the goals and eligibility requirements target homeless people and mainstream programs that serve homeless people as well as other low-income people, for example, Medicaid, Temporary Assistance to Needy Families (TANF), or mainstream housing and community development programs (Section 8, public housing, Community Development Block Grant, HOME). The figures below focus on how much is spent on dedicated homeless assistance programs and examine trends in HUD funding for low-income housing programs. In 2006, the federal government spent $1.928 billion dollars on dedicated homeless programs. The Assistance Grants is the primary source of funding for homeless people. McKinney-Vento funds Emergency Shelter Grants, Supportive Housing programs, and Shelter Plus Care. Since 2001, McKinney-Vento Homeless Assistance funding has been increasing slightly, with a dip in Other major programs for homelessness programs include Health Care for the Homeless, funded by the HHS, and the Emergency Food and Shelter Program, funded by the DHS. Federal spending on homelessness is on an upward trajectory. From 2001 to 2006, dedicated federal funding for homelessness increased 9 percent, from $1.762 to $1.928 billion. If approved, the President s FY 2007 budget request of $2.140 billion would continue this trend, increasing federal homeless spending by 10 percent from 2006 to While federal funding for homeless assistance programs has increased slightly, funding for housing assistance programs for low-income households a critical component of ending homelessness has not increased significantly since In 2001, federal funding for housing assistance totaled $29 billion; funding increased to $31.7 billion in 2003 and then decreased slightly in 2005 ($31 billion) and 2006 ($31.4 billion).

23 What Is Housing First? Housing First is an approach that guides a set of interventions designed to help homeless families or individuals transition more rapidly out of the shelter system; it includes crisis intervention, re-housing as quickly as possible, follow-up case management, and housing support services to prevent the reoccurrence of homelessness. The approach is based on two basic principles: (1) the best way to end homelessness for the vast majority of people is to help them move into permanent housing as quickly as possible; and (2) once in housing, formerly homeless people may require some level of services to help them stabilize, link them to long-term supports, and prevent reoccurrence. What differentiates a Housing First approach from traditional emergency housing or transitional models is that there is an immediate and primary focus on helping those in need quickly access and then sustain housing put simply, housing comes first, then services. While Housing First interventions may sound intuitive (homeless people need housing), the addition of Housing First services in a community can radically transform how people experience homelessness. Further, once a family or an individual is in housing, that family or individual is more responsive to interventions and support that lead to better outcomes. What Is Permanent Supportive Housing? Permanent supportive housing (PSH) is affordable housing linked to support services. A PSH unit is intended for a person or family whose head of household is homeless or at risk of homelessness and experiencing mental illness, other chronic health conditions including substance use issues, and/or multiple barriers to employment and housing stability. Typically, the tenant pays no more than 30 to 50 percent of household income toward rent and has a lease or similar form of occupancy agreement with no limits on length of tenancy, as long as the household abides by the conditions of the lease. Additionally, the tenant has access to a flexible array of comprehensive services including medical and wellness, mental health, substance use management and recovery, vocational and employment, money management, coordinated support (case management), life skills, household establishment, and tenant advocacy. 49 Nonprofits develop PSH using different funding streams for operating costs, services costs, and capital. Section 8 vouchers and Shelter Plus Care are often used for operating costs. Services are more difficult to fund; generally, organizations must piece together different sources of services financing in order to run their programs. There are many benefits of permanent supportive housing. PSH reduces the use of other public systems by its consumers and prevents people from becoming or remaining homeless for extended periods. In one study, placement in PSH led to 19

24 decreases of more than 50 percent in emergency room visits and hospital inpatient days, and an increase of 50 percent in earned income. 50 PSH works in part because it addresses the top priorities of many of its clients. Mothers who are part of the Family Permanent Supportive Housing Initiative listed their two most desired housing characteristics as having a sense of privacy and having a key to their own place, both of which were achieved in that program. 51 For PSH consumers who have mental illness, substance abuse problems, or other disabilities, the structure of integrated yet separate housing and services allows for a sense of normality; they live independently in an apartment for which they have signed a lease, just like any tenant renting an apartment in the private market. Supportive services that are linked to the unit help them remain housed and enhance their quality of life and well-being. PSH is a proven solution to ending homelessness for chronically homeless people. Currently, there are somewhere between 20,000 and 30,000 units of PSH providing services. 52 What Is the Ten Year Plan? How Many Local Ten Year Plans Exist? In 2000, the Alliance announced A Plan, Not a Dream: How to End in Ten Years. This plan offers a framework on how communities can end homelessness by planning for outcomes, closing the front door to homelessness, opening the back door out of homelessness, and building infrastructure. The announcement of this plan created a snowball effect across the country. The Bush Administration and Congress have adopted as goals significant parts of the Ten Year Plan, and opinion leaders have begun to echo the language and key concepts of the plan. Moreover, cities and states across the nation have taken up the challenge to end homelessness in their communities. Today more than 220 communities are planning to end homelessness; over 92 have completed plans. Across the country, the movement to end homelessness is growing. Endnotes 20 1 Burt, M. R., and Aron, L. Y America s Homeless II: Populations and Services. Washington, DC: The Urban Institute. 2 National Alliance to End Counts. Washington, DC: Author. 3 Culhane, D Family : Where to From Here? October 14, 2004 to the National Alliance to End Conference on Ending Family. PowerPoint available online at 4 Burt, M. R What Will it Take to End? Washington, DC: Urban Institute. 5 Ibid.

25 6 Shin, M., Weitzman, B. C., Stojanovic, D. Knickman, J. R., Jimenez, L., Duchon, L., James, S., and Krantz, D. H Predictors of homelessness among families in New York City: From shelter request to housing stability. American Journal of Public Health, 88 (11): Ibid. 8 Bassuk, E. L., Buckner, J. C., Weinreb, L. F., Browne, A., Bassuk, S. S., Dawson, R., and Perloff, J. N in female-headed families: Childhood and adult risk and protective factors. American Journal of Public Health, 87 (2): Shin, M., Weitzman, B. C., Stojanovic, D. Knickman, J. R., Jimenez, L., Duchon, L., James, S., and Krantz, D. H Predictors of homelessness among families in New York City: From shelter request to housing stability. American Journal of Public Health, 88 (11): Ibid. 11 Pelletiere, D., Wardrip, K., and Crowley, S Out of Reach: Washington, DC: National Low Income Housing Coalition. 12 Burt, M. R., Aron, L. Y., Douglas, T., Valente, J., Lee, E., and Iwen, B : Programs and the People They Serve, Findings of the National Survey of Homeless Assistance Providers and Clients Technical Report. Urban Institute. Washington, DC: Interagency Council on the Homeless. 13 Kuhn, R. & Culhane, D. P Applying cluster analysis to test of a typology of homelessness: Results from the analysis if administrative data. American Journal of Community Psychology, 17 (1), According to HUD s definition, a person who is chronically homeless is an unaccompanied homeless individual with a disabling condition who has either been continuously homeless for a year or more, or has had at least four (4) episodes of homelessness in the past three (3) years. In order to be considered chronically homeless, a person must have been sleeping in a place not meant for human habitation (e.g., living on the streets) and/or in an emergency homeless shelter. A disabling condition is defined as a diagnosable substance use disorder, serious mental illness, developmental disability, or chronic physical illness or disability including the co-occurrence of two or more of these conditions. A disabling condition limits an individual s ability to work or perform one or more activities of daily living. 15 National Alliance to End tabulations of Continuum of Care 2005 point in time estimates. 16 Kuhn, R. & Culhane, D. P Applying cluster analysis to test of a typology of homelessness: Results from the analysis if administrative data. American Journal of Community Psychology, 17 (1), Burt, M. R., Aron, L. Y., Douglas, T., Valente, J., Lee, E., and Iwen, B : Programs and the People They Serve, Findings of the National Survey of Homeless Assistance Providers and Clients Technical Report. Urban Institute. Washington, DC: Interagency Council on the Homeless. 18 U.S. Census Bureau and U.S. Department of Housing and Urban Development (2004). 19 Aron, L. Y., and Fitchen, J. M Rural : A Synopsis. in America (Jim Baumohl, ed.). Phoenix, AZ: Oryx Press. 20 U.S. Census Bureau and United States Department of Housing and Urban Development American Housing Survey for the United States: Washington, DC. Available at gov/prod/2004pubs/h pdf. 21 Housing Assistance Council Taking Stock: Rural People, Poverty, and Housing at the Turn of the 21st Century. Washington, DC. Available at 1TSfrontice.pdf. 22 Carsey Institute Child Poverty in Rural America: New Data Shows Increases in 41 States. Durham, NH: University of New Hampshire. 23 Burt, M. R., Aron, L. Y., Douglas, T., Valente, J., Lee, E., and Iwen, B : Programs and the People They Serve, Findings of the National Survey of Homeless Assistance Providers and Clients Technical Report. Urban Institute. Washington, DC: Interagency Council on the Homeless. 24 Van Gundy, K Substance Abuse in Rural and Small Town America. Carsey Institute. Durham, NH: University of New Hampshire. 25 Robertson, M. J., and Toro, P. A Homeless Youth: Research, Invention, Policy. National Symposium on Research. Washington, DC: U.S. Department of Health and Human Services 26 Center for Law and Social Policy Leave No Youth Behind: Opportunities to Reach Disconnected Youth, p Allen, M., and Nixon, R The Foster Care Independence Act and the John H. Chafee Foster Care Independence Program: New catalyst for reform for young people aging out of foster care. Journal of Poverty and Policy, July August. 28 Anne E. Casey Foundation Kids Count Data Book Washington, DC: Annie E. Casey Foundation. 29 National Law Center on and Poverty Legal Tools to End Washington, DC: National Law Center on and Poverty. 21

26 22 30 Healthcare for the Homeless Clinician s Network. Protecting the Mental Health of Homeless Children and Youth. Healing Hands, 4(1), Feb Rosenheck, R. A., Lea, C., Frisman, L. K., Lam, J., and Chung, A Homeless Veterans. in America (Jim Baumohl, ed.). Phoenix, AZ: Oryx Press. 32 Burt, M. R., Aron, L. Y., Douglas, T., Valente, J., Lee, E., and Iwen, B : Programs and the People They Serve. Findings of the National Survey of Homeless Assistance Providers and Clients. Washington, DC: Interagency Council on the Homeless. 33 Rosenheck, R. A., Lea, C., Frisman, L. K., Lam, J., and Chung, A Homeless Veterans. in America (Jim Baumohl, ed.). Phoenix, AZ: Oryx Press. 34 U.S. Department of Veterans Affairs The Iraq War Clinician Guide, 2nd Edition. Washington, DC:. U.S. Department of Veterans Affairs 35 The number of people released from state prisons each year has been steadily increasing from slightly more than 600,000 in 2000 to more than 670,000 in See Paige M. Harrison and Allen J. Beck, Prison and Jail Inmates at Midyear 2005, U.S. Department of Justice, Bureau of Justice Statistics (Washington, DC, 2006), NCJ The jail numbers (2004) were provided by Allen J. Beck, The Importance of Successful Reentry to Jail Population Growth (presentation at The Jail Reentry Roundtable of the Urban Institute, Washington, DC, June 27, 2006). 37 Metraux, Stephen and Dennis Culhane Homeless Shelter Use and Reincarceration Following Prison Release. Criminology and Public Policy 3(2): Burt, M. R., et al., : Programs and the People They Serve: Findings From the National Survey of Homeless Assistance Providers and Clients, U.S. Department of Housing and Urban Development (Washington, DC: 1999), cited in Stephen Métraux and Dennis P. Culhane Homeless Shelter Use and Reincarceration Following Prison Release: Assessing the Risk, Criminology & Public Policy 3(2): Metraux, Stephen and Dennis Culhane Homeless Shelter Use and Reincarceration Following Prison Release. Criminology and Public Policy 3(2): The Lewin Group Costs of Serving Homeless Individuals in Nine Cities. Chart Book Report. New York: Corporation for Supportive Housing. 41 Culhane, D. P., et al Public Service Reductions Associated with Placement of Homeless Persons with Severe Mental Illness in Supportive Housing, in Housing Policy Debate, Vol. 13, Issue 1. Fannie Mae Foundation. 42 Burt, M. R., Aron, L. Y., Douglas, T., Valente, J., Lee, E., and Iwen, B : Programs and the People They Serve. Findings of the National Survey of Homeless Assistance Providers and Clients. Washington, DC: Interagency Council on the Homeless. 43 Bassuk, E.L, Melnick, S. and Brone, A Responding to the needs of low Income and homeless women who are survivors of family violence. Journal of American Medical Association, 53(2): Ibid. 45 Health Care for the Homeless Council Health Care and. Washington, DC: Health Care for the Homeless Council. 46 Burt, M. R., Aron, L. Y., Douglas, T., Valente, J., Lee, E., and Iwen, B : Programs and the People They Serve. Findings of the National Survey of Homeless Assistance Providers and Clients. Washington, DC: Interagency Council on the Homeless. 47 Rosenheck, R., Barruk, E., and Salomon, A Special Populations of Homeless Americans. In Fosburg, L., and Dennis, D. (eds), Practical Lessons. Washington, DC: HHS & HUD. Koegel, P., Burnam, M.A., and Baumohl, J The Causes of. In Baumohl, J. (ed), in America. Phoenix, AZ: Oryx Press, pp Cordray, D., and Lehman, A Prevalence of alcohol, drug, and mental disorders among the homeless. Contemporary Drug Problems 20: Burt, M. R., Aron, L. Y., Douglas, T., Valente, J., Lee, E., and Iwen, B : Programs and the People They Serve. Findings of the National Survey of Homeless Assistance Providers and Clients. Washington, DC: Interagency Council on the Homeless. 49 Corporation for Supportive Housing. March What Is Supportive Housing? Oakland, CA: Corporation for Supportive Housing. 50 Culhane, D. P., Metraux, S & Hadley, T.R Public service reductions associated with the placement of homeless people with severe mental illness in supportive housing. Housing Policy Debate, 13 (1), Burt, M. R., and Nolan, C The Family Permanent Supportive Housing Initiative: Preliminary Findings Report. Washington, DC: Urban Institute. 52 Corporation for Supportive Housing tabulations of permanent supportive housing units 2006.